Sleep-Related Breathing Disorders in the Elderly

Sleep-related breathing disorders (SRBDs) are much more common in older adults than among middle-aged adults, with up to 20% of older adults having an AHI ≥15 events per hour. Changes in upper airway anatomy and muscle function with aging may play a role. Traditional risk factors such as body mass index and history of snoring can help increase the pretest probability for SRBD, but are not as strongly associated with SRBD in older adults as they are in younger subjects. Patients with cognitive impairment have higher rates of SRBD. Evaluation of SRBD relies on polysomnography (PSG) in older adults, with portable PSG representing a potentially useful tool especially in older adults with caregiving responsibilities or functional impairments. Treatment pathways for older adults should take into account possible upper extremity weakness that may limit their ability to apply positive airway pressure masks, assessment of cognitive capacity, and caregiver/social support networks. Weight loss is generally not recommended for mildly overweight patients, but may be appropriate in obese patients. Data on the efficacy of surgical therapies is limited in older adults.